Psych EXAM 2 study

TCAs

amitriptyline nortriptyline protriptyline imipramine clomipramine trimipramine desipramine amoxapine doxepine

persistent depressive disorder diagnosis

at least 2 years no manic episodes no thoughts of death or suicide

atypical antidepressants

bupropion mirtazapine maprotiline trazodone nefazodone

delusions of persecution VS paranoid delusions

delusions of persecution = believe you are being persecuted or treat badly in some way "FBI bugged my room and want to kill me" paranoid delusions = extreme suspiciousness of others "They poisoned my food"

What are anticholinergic effects?

dry mouth blurred vision constipation paralytic ileus urinary retention tachycardia elevated temperature decreased sweating

SNRIs

duloxerine venlafaxine desvenlafaxine

MAOIs

phenelzine selegiline tranylcypromine isocarboxazid system

Which statement indicates to the nurse that a client is experiencing a delusion? 1. "Spies are watching everything I do." 2. "There is a worm on the back of the television." 3. "Bugs are crawling all over me." 4. "I really don't feel like going to group today."

1. "Spies are watching everything I do." 1. This is correct. This statement indicates the client is experiencing a delusion. Delusions are fixed, false beliefs that are irrational and that the individual maintains are true despite evidence to the contrary. 2. This is incorrect. This statement is an example of an illusion. Illusions are misperceptions or misinterpretations of real external stimuli. "Spies are watching everything I do" is an example of a delusion. Delusions are fixed, false beliefs that are irrational and that the individual maintains are true despite evidence to the contrary. 3. This is incorrect. This statement indicates the client is experiencing a tactile hallucination. Tactile hallucinations are false perceptions of the sense of touch, often of something on or under the skin. "Spies are watching everything I do" is an example of a delusion. Delusions are fixed, false beliefs that are irrational and that the individual maintains are true despite evidence to the contrary. 4. This is incorrect. This statement is an example of avolition (lack of motivation), a negative symptom of schizophrenia. "Spies are watching everything I do" is an example of a delusion. Delusions are fixed, false beliefs that are irrational and that the individual maintains are true despite evidence to the contrary.

major depressive disorder diagnosis

2 week period of depressed no history of manic episode recurrent thoughts of death/suicidal ideations

A client admitted to the psychiatric unit following a suicide attempt is diagnosed with MDD. Which behavioral symptoms should the nurse expect to assess? 1. Anxiety and unconscious anger 2. Lack of attention to grooming and hygiene 3. Guilt and indecisiveness 4. Low self-esteem

2. Lack of attention to grooming and hygiene 1. This is incorrect. Anxiety and anger are affective symptoms. 2. This is correct. Lack of attention to grooming and hygiene is a behavioral symptom of MDD. 3. This is incorrect. Guilt is an affective symptom, and indecisiveness is a cognitive symptom. 4. This is incorrect. Low self-esteem is an affective symptom

A client diagnosed with brief psychotic disorder tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

ANS: C The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is at risk for responding and reacting to the command hallucination. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

Laboratory results reveal elevated levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, the nurse should expect to observe which symptoms? Select all that apply. A. Apathy B. Social withdrawal C. Anhedonia D. Galactorrhea E. Gynecomastia

ANS: D, E Dopamine blockage, an expected action of antipsychotic medications, also results in prolactin elevation. Galactorrhea and gynecomastia are symptoms of prolactin elevation.

___________________________ are false sensory perceptions not associated with real external stimuli and may involve any of the five senses.

Hallucinations

Typical antipsychotics

Haloperidol Chlorpromazine Fluphenazine Perphenazine Prochlorperazine Thioridazine Trifluoperazine Thiothixene Loxapine Pimozide

side effects of light therapy for SAD/depression

headache eyestrain nausea irritability photophobia (sensitivity to light) insomnia hypomania

A client is admitted with a diagnosis of PDD. Which client statement describes a symptom consistent with this diagnosis? 1. "I have been sad most of the time for the past several years." 2. "I find myself preoccupied with death." 3. "Sometimes I hear voices telling me to kill myself." 4. "I'm afraid to leave the house."

1. "I have been sad most of the time for the past several years."

A client is admitted to the psychiatric unit with a diagnosis of MDD. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this client's plan of care? 1. A simple, structured daily schedule with limited choices of activities 2. A daily schedule filled with activities to promote socialization 3. A flexible schedule that allows the client opportunities for decision-making 4. A schedule that includes mandatory activities to decrease social isolation

1. A simple, structured daily schedule with limited choices of activities

The psychiatric-mental health nurse is evaluating the care of a client recovering from an episode of psychosis. Which is the most appropriate long-term goal for the client? 1. Define and test reality. 2. Participate in social activities. 3. Maintain appropriate eye contact. 4. Verbalize feelings of anxiety.

1. Define and test reality.

Which of the following best defines secondary depression? 1. Depressive symptoms that occur as a consequence of an adverse side effect of certain medications. 2. Depressive symptoms as a result of MDD exacerbation and elevated serotonin levels. 3. Depressive symptoms that occur as a result of psychomotor retardation. 4. Depressive symptoms that occur with abrupt discontinuation of antidepressants.

1. Depressive symptoms that occur as a consequence of an adverse side effect of certain medications The DSM-5 stipulates that medical conditions should be identified before a psychiatric diagnosis is made, as symptoms of a medical condition may mimic those of psychiatric disorders. Depressive symptoms that occur as a consequence of a non-mood disorder or as an adverse effect of certain medications are known as secondary depression. Secondary depression may be related to medication side effects, neurological disorders, electrolyte or hormonal disturbances, nutritional deficiencies, and other physiological or psychological conditions.

A client diagnosed with MDD was raised in a strongly religious family where bad behavior was equated with sins against God. Which nursing intervention is most appropriate to help the client address spirituality as it relates to the illness? 1. Encourage the client to bring into awareness underlying sources of guilt. 2. Teach the client that religious beliefs should be put into perspective. 3. Confront the client with the irrational nature of the belief system. 4. Assist the client to modify his or her belief system to improve coping skills.

1. Encourage the client to bring into awareness underlying sources of guilt.

The diagnosis of catatonic disorder associated with another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.) 1. Hyperthyroidism 2. Hypothyroidism 3. Hyperadrenalism 4. Hypoadrenalism 5. Hyperaphia

1. Hyperthyroidism 2. Hypothyroidism 3. Hyperadrenalism 4. Hypoadrenalism 1. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders such as hyperthyroidism. 2. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hypothyroidism. 3. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hyperadrenalism. 4. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hypoadrenalism. 5. Hyperaphia is an excessive sensitivity to touch.

4. Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client? 1. On his or her side, to prevent aspiration 2. In high Fowler's position, to prevent increased intracranial pressure 3. In Trendelenburg's position, to promote blood flow to vital organs 4. In prone position, to prevent airway blockage

1. On his or her side, to prevent aspiration The nurse should place a client who has received ECT on his or her side to prevent aspiration.

The parent of a 20-year-old client recently diagnosed with paranoid schizophrenia asks the nurse what causes schizophrenia. The nurse recognizes which of the following are implicated in the etiology of schizophrenia? Select all that apply. 1. Prostaglandins 2. Glutamate 3. Thyroxine 4. Dopamine 5. Erythropoietin

1. Prostaglandins 2. Glutamate 4. Dopamine

Order the spectrum of schizophrenic and other psychotic disorders as described by the DSM-5 on a gradient of psychopathology from least to most severe. ________ Delusional disorder ________ Schizotypal personality disorder ________ Schizophrenia ________ Brief psychotic disorder ________ Psychotic disorder associated with another medical condition ________ Catatonic disorder associated with another medical condition ________ Schizoaffective disorder ________ Schizophreniform disorder ________ Substance-induced psychotic disorder

1. Schizotypal personality disorder 2. Delusional disorder 3. Brief psychotic disorder 4. Substance-induced psychotic disorder 5. Psychotic disorder associated with another medical condition 6. Catatonic disorder associated with another medical condition 7. Schizophreniform disorder 8. Schizoaffective disorder 9. Schizophrenia

The nurse expects a client experiencing prodromal symptoms of schizophrenia to demonstrate which of the following? 1. Significant deterioration in functioning 2. Poor relationships with peers 3. Disturbances in thought processing 4. Disorganized motor behavior

1. Significant deterioration in functioning 1. This is correct. An individual begins to show signs of significant deterioration in premorbid functioning during the prodromal phase of schizophrenia. 2. This is incorrect. An individual begins to show signs of significant deterioration in premorbid functioning during the prodromal phase of schizophrenia. Poor peer relationships are seen during the PREMORBID phase. 3. This is incorrect. An individual begins to show signs of significant deterioration in premorbid functioning during the prodromal phase of schizophrenia. Disturbances in thought processing and disorganized motor behavior are seen during the active psychotic phase. 4. This is incorrect. An individual begins to show signs of significant deterioration in premorbid functioning during the prodromal phase of schizophrenia. Disturbances in thought processing and disorganized motor behavior are seen during the active psychotic phase.

The nurse suspects the client of having MDD due to the client having psychomotor retardation. Which of the following would be an example of psychomotor retardation? 1. The client is disheveled and malodorous. 2. The client exhibits promiscuous behaviors. 3. The client ambulates independently. 4. The client has maxed-out charge cards.

1. The client is disheveled and malodorous. 1. This is correct. Psychomotor retardation can manifest as being disheveled and malodorous. 2. This is incorrect. Hypersexuality is a symptom of mania, not depression. 3. This is incorrect. This is not an example of psychomotor retardation. 4. This is incorrect. Excessive spending is a symptom of mania. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria indicate a diagnosis of MDD is appropriate when there is no history of manic behavior.

9. A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis? 1. Thyroid-stimulating hormone (TSH) level of 25 U/mL 2. Potassium (K+) level of 4.2 mEq/L 3. Sodium (Na+) level of 140 mEq/L 4. Calcium (Ca2+) level of 9.5 mg/dL

1. Thyroid-stimulating hormone (TSH) level of 25 U/mL A diagnosis of major depressive episode may be ruled out if the client's lab results reveal a TSH level of 25 U/mL. Normal levels of TSH range from 2 to 10 U/mL. High levels of TSH indicate low thyroid function. The client's high TSH value may indicate hypothyroidism, which can lead to depressive symptoms. The DSM-5 criteria for the diagnosis of major depressive episode states that this diagnosis must not be attributable to the direct physiological effects of another medical condition.

A client who has been taking fluvoxamine (Luvox) without significant improvement asks the nurse, "I heard about something called monoamine oxidase inhibitors (MAOIs). Can't my doctor add that to my medications?" Which is the most appropriate nursing reply? 1. "This combination of drugs can lead to delirium tremens." 2. "A combination of an MAOI and fluvoxamine can lead to a life-threatening hypertensive crisis." 3. "That's a good idea. There have been good results with the combination of these two drugs." 4. "The only disadvantage would be the exorbitant cost of the MAOI."

2. "A combination of an MAOI and fluvoxamine can lead to a life-threatening hypertensive crisis." Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of dread.

The nurse is educating the parents of a child diagnosed with schizophrenia on how to reply when their child experiences auditory hallucinations. Which is the nurse's best reply? 1. "Tell him to stop talking about the voices." 2. "Ask him what the voices are saying to him." 3. "Tell him you know the voices are real to him." 4. "Encourage him not to worry about the voices."

2. "Ask him what the voices are saying to him." Safety is always the nurse's priority. The parents should ask what the voices are saying to identify whether the child is hearing commands to harm self or others. The nurse should encourage the parents to acknowledge the voices are real to the child, but let the child know they do not share the perception. Use of the word "voices" helps avoid reinforcing the hallucination.

The nurse is implementing a one-on-one suicide observation level with a client diagnosed with MDD. The client states, "I'm feeling a lot better, so you can stop watching me. I have taken up too much of your time already." Which is the best nursing reply? 1. "I really appreciate your concern, but I have been ordered to continue to watch you." 2. "Because we are concerned about your safety, we will continue to observe you." 3. "I am glad you are feeling better. The treatment team will consider your request." 4. "I will forward your request to your psychiatrist because it is his decision."

2. "Because we are concerned about your safety, we will continue to observe you."

A newly admitted client diagnosed with MDD states, "I have never considered suicide." Later, the client confides to the nurse about plans to "end it all" by medication overdose. Which is the most helpful nursing reply? 1. "There is nothing to worry about. We will handle it together." 2. "Bringing this up is a very positive action on your part." 3. "We need to talk about the things you have to live for." 4. "I think you should consider all of your options prior to taking this action."

2. "Bringing this up is a very positive action on your part."

21. After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "Are you taking St. John's wort?"

2. "How many packs of cigarettes do you smoke daily?"

An isolative client was admitted 4 days ago with a diagnosis of MDD. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? 1. "We'll go to the dayroom when you are ready for group." 2. "I'll walk with you to the dayroom. Group is about to start." 3. "It must be difficult for you to attend group when you feel so bad." 4. "Let me tell you about the benefits of attending this group."

2. "I'll walk with you to the dayroom. Group is about to start."

14. A nurse is working with a client who has just been prescribed buproprion (Wellbutrin). Which statement by the client indicates that further education is necessary? 1. "I will begin using sunblock when outdoors." 2. "If I miss a dose, I will just take two pills the next day to catch up." 3. "I will only discontinue the medication under the guidance of my physician." 4. "I will use caution when driving and using dangerous machinery."

2. "If I miss a dose, I will just take two pills the next day to catch up." Clients should never double up on a dose if they miss a day, as this could increase the risk of seizures or other adverse reactions.

A client who is diagnosed with MDD asks the nurse what causes depression. Which is the nurse's most accurate response? 1. "Depression is caused by a deficiency in neurotransmitters, including serotonin and norepinephrine." 2. "The exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role." 3. "Depression is a learned state of helplessness caused by ineffective parenting." 4. "Depression is caused by intrapersonal conflict between the id and the ego."

2. "The exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role."

A client exhibits paranoia, bizarre behaviors, neologisms, and delusions of persecution. While eating breakfast in the dayroom, the client starts yelling at others. Which is the nurse's first action? 1. Ensure client is swallowing each dose of medication. 2. Ask other clients to step out of the dayroom. 3. Call the provider for an order to place the client in restraints. 4. Escort the client to a less-stimulating environment.

2. Ask other clients to step out of the dayroom This is correct. Safety is always the nurse's priority. The nurse should move the other clients away from the client to protect them from harm.

A newly admitted client is diagnosed with MDD with suicidal ideations. Which is the priority nursing intervention for this client? 1. Teach about the effect of suicide on family dynamics. 2. Carefully observe at varied intervals. 3. Encourage the client to spend a portion of each day interacting within the milieu. 4. Set realistic achievable goals to increase self-esteem and increase energy.

2. Carefully observe at varied intervals.

What is the priority reason for the nurse to perform a full physical health assessment on a client admitted with a diagnosis of MDD? 1. The attention during the assessment is beneficial in decreasing social isolation. 2. Depression is a symptom of several medical conditions. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed clients avoid addressing physical health and ignore medical problems.

2. Depression is a symptom of several medical conditions. 1. This is incorrect. Although social interaction may be an unintended result, it is not a priority reason for this assessment. 2. This is correct. It is a priority to identify and treat medical conditions because depressive symptoms may occur as a consequence of a nonmood disorder related to medication side effects, neurological disorders, electrolyte or hormonal disturbances, nutritional deficiencies, and other physiological or psychological conditions. 3. This is incorrect. This is not the priority reason for the full assessment. Although many antidepressants may cause physical side effects, that is not the priority reason for completing a full physical assessment. 4. This is incorrect. Depressed clients may ignore chronic health issues, but that is not the priority for the full physical assessment

The nurse is administering medications to a client experiencing acute psychosis. The client's medication orders include haloperidol 50 mg PO bid; benztropine 1 mg PO daily, and zolpidem 10 mg PO at bedtime daily. The nurse administers benztropine to address which of the following? 1. Tactile hallucinations 2. Involuntary facial movements 3. Psychomotor retardation 4. Pacing back and forth

2. Involuntary facial movements 2. This is correct. Benztropine is an anticholinergic medication used for symptoms of tardive dyskinesia, characterized by abnormal involuntary movements. Tardive dyskinesia is a potentially irreversible adverse effect of antipsychotic medications.

18. The severity of depressive symptoms in the postpartum period varies from a feeling of the "blues," to moderate depression, to psychotic depression or melancholia. Which disorder is correctly matched with its presenting symptoms? 1. Maternity blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions) 2. Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) 3. Postpartum melancholia (overprotection of infant, expresses concern about inability to care for baby, mysophobia) 4. Postpartum depressive psychosis (transient depressed mood, agitation, abnormal fear of child abduction, suicidal ideations)

2. Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) Symptoms of postpartum depression are associated with fatigue, irritability, loss of appetite, sleep disturbances, loss of libido, and expressions of great concern about her inability to care for her baby

A client is diagnosed with major depressive disorder (MDD). Which nursing diagnosis should the nurse assign to the client to address a behavioral symptom of this disorder? 1. Altered communication related to (R/T) feelings of worthlessness as evidenced by (AEB) anhedonia 2. Social isolation R/T poor self-esteem AEB secluding self in room 3. Altered thought processes R/T hopelessness AEB persecutory delusions 4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

2. Social isolation R/T poor self-esteem AEB secluding self in room 1. This is incorrect. Feelings of worthlessness are affective symptoms. 2. This is correct. The nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of MDD. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, maintaining a fetal position, and no personal hygiene and/or grooming. 3. This is incorrect. Persecutory delusions are cognitive symptoms. 4. This is incorrect. Anorexia is a physiological symptom.

A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis? 1. The client has experienced impaired reality testing for a 24-hour period. 2. The client has experienced auditory hallucinations for the past 3 hours. 3. The client has experienced bizarre behavior for 1 day. 4. The client has experienced confusion for 3 weeks.

2. The client has experienced auditory hallucinations for the past 3 hours. 1 Impaired reality testing for a 24-hour period is typical of brief psychotic disorder and would not cause the nurse to question this diagnosis. 2 This disorder is identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month. 3 Bizarre behavior for 1 day is typical of brief psychotic disorder and would not cause the nurse to question this diagnosis. 4 Confusion for 3 weeks is typical of brief psychotic disorder and would not cause the nurse to question this diagnosis.

The nursing instructor asks a nursing student to describe concepts of the Recovery Model. Which concepts should the nursing student include? Select all that apply. 1. Employs positive and negative reinforcement 2. Uses personal values to determine meaning in life 3. Focuses on interactions within a social environment 4. Centers on improving adherence to prescribed medications 5. Allows client primary control over care decisions

2. Uses personal values to determine meaning in life 5. Allows client primary control over care decisions 1. This is incorrect. The Recovery Model highlights the dimension of active engagement and empowerment of the client in decision making. The client identifies goals based on personal values or what they define as giving meaning and purpose to life. Behavior therapy attaches positive, negative, and aversive reinforcements to adaptive and maladaptive behaviors. 2. This is correct. The Recovery Model highlights the dimension of active engagement. The client identifies goals based on personal values or what they define as giving meaning and purpose to life. 3. This is incorrect. The Recovery Model highlights the dimension of active engagement and empowerment of the client in decision-making. The client identifies goals based on personal values or what they define as giving meaning and purpose to life. Milieu therapy focuses on a client's interaction within a social environment. 4. This is incorrect. The Recovery Model highlights empowering the client in decisionmaking. Family therapy focuses on improving adherence to prescribed medications. 5. This is correct. The Recovery Model highlights the dimension of active engagement and empowerment of the client in decision making. The client identifies goals based on personal values or what he or she defines as giving meaning and purpose to life.

8. A client who has been newly diagnosed with depression is beginning tricyclic antidepressant therapy. The nurse has just completed teaching with this client. Which statement by the client indicates the need for further education? 1. "I will continue to take this medication even if the symptoms have not subsided." 2. "I may experience drowsiness or dizziness while taking this medication." 3. "I do not need to quit smoking." 4. "I will stop drinking alcohol now that I am taking this medication."

3. "I do not need to quit smoking." Clients should not smoke when taking this medication, as smoking increases the metabolism of tricyclic antidepressants.

A nurse is assessing a client diagnosed with substance induced psychotic disorder (SIPD). What would differentiate this client's symptoms from the symptoms of a client diagnosed with brief psychotic disorder (BPD)? 1. Clients diagnosed with SIPD experience delusions, whereas clients diagnosed with BPD do not. 2. Clients diagnosed with BPD experience hallucinations, whereas clients diagnosed with SIPD do not. 3. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features. 4. Catatonic features may be associated with BPD, whereas SIPD has no catatonic features.

3. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features. 1 Hallucinations and delusions are associated with SIPD and BPD. 2 Hallucinations and delusions are associated with BPD and SIPD. 3 Catatonic features may be associated with SIPD, whereas BPD has no catatonic features. 4 Catatonic features may be associated with SIPD.

The nurse is providing counseling to clients diagnosed with MDD. The nurse chooses to help the clients alter their mood by learning how to change the way they think. The nurse is functioning under which theoretical framework? 1. Psychoanalytic theory 2. Interpersonal theory 3. Cognitive theory 4. Behavioral theory

3. Cognitive theory 1. This is incorrect. Psychoanalytical theory is attributed to Freud (1957), who asserted that melancholia occurs after the loss of a loved object, either actually by death or emotionally by rejection, or the loss of some other abstraction of value to the individual. 2. This is incorrect. Interpersonal psychotherapy focuses on the client's current interpersonal relations. 3. This is correct. Beck and colleagues (1979) proposed a theory suggesting that the primary disturbance in depression is cognitive rather than affective. The underlying cause of the depression is cognitive distortions that result in negative thinking. 4. This is incorrect. Behavioral theory is a type of learning theory.

A depressed client reports to the nurse a history of divorce, job loss, family estrangement, and cocaine abuse. According to learning theory, which is the cause of this client's symptoms? 1. Depression is a result of anger turned inward. 2. Depression is a result of abandonment. 3. Depression is a result of repeated failures. 4. Depression is a result of negative thinking

3. Depression is a result of repeated failures. 1. This is incorrect. Psychoanalytical theory (Freud, 1957) indicates depression is a result of anger turned inward. 2. This is incorrect. Object loss theory suggests that depressive illness occurs as a result of having been abandoned by or otherwise separated from a significant other during the first 6 months of life. 3. This is correct. Learning theory describes Seligman's model (1973), which asserts a state of "learned helplessness" exists in humans who have experienced numerous failures and predisposes individuals to depression by imposing a feeling of lack of control over their life situations. 4. This is incorrect. Cognitive theory (Beck et al., 1979) suggests depression is the result of cognitive distortions that result in negative, defeated attitudes.

A client states, "The voices keep saying I am evil." Which outcome criteria is most important to include in the client's plan of care? 1. Demonstrates the ability to perceive the environment correctly 2. Uses appropriate verbal communication when interacting with others 3. Identifies factors that increase anxiety and illicit hallucinations 4. Demonstrates the ability to relate satisfactorily to others

3. Identifies factors that increase anxiety and illicit hallucinations The most important outcome is that the client can identify factors that increase anxiety and trigger hallucinations. Symptoms of psychosis may be minimized or prevented if the patient can learn techniques to interrupt escalating anxiety.

6. A client diagnosed with major depressive episode hears voices commanding selfharm. Which should be the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations 4. Encouraging client to express feelings related to suicide

3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations The nurse's priority intervention when a depressed client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideations. By providing one-to-one observation, the nurse will be able to interrupt any attempts at suicide.

Which is associated with premenstrual dysphoric disorder (PMDD)? 1. Norepinephrine 2. Serotonin 3. Progesterone 4. Acetylcholine

3. Progesterone An imbalance of the hormones estrogen and progesterone has been implicated in the predisposition to PMDD

A 75-year-old client with a long history of depression is currently taking doxepin (Sinequan) 100 mg daily. The client also takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority? 1. Risk for ineffective thermoregulation R/T anhidrosis 2. Risk for constipation R/T excessive fluid loss 3. Risk for injury R/T orthostatic hypotension 4. Risk for infection R/T suppressed white blood cell count

3. Risk for injury R/T orthostatic hypotension Orthostatic hypotension is a side effect of the tricyclic antidepressant doxepin (Sinequan), placing the client at risk for injury. Dehydration related to flu symptoms and a diuretic further increases the risk for orthostatic hypotension

Which client information does the nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? 1. The client's understanding of the need for regular blood work 2. The client's mood and affect score, according to the facility's mood scale 3. The client's cognitive ability to understand information about the medication 4. The client's access to a support network willing to participate in treatment

3. The client's cognitive ability to understand information about the medication The nurse must assess the client's cognitive ability to understand information about the medication. Phenelzine (Nardil) is an MAOI. To avoid a hypertensive emergency, clients taking MAOIs should not ingest foods high in tyramine, take certain medications, or use alcohol.

3. A nurse administers 100 percent oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure? 1. To prevent increased intracranial pressure resulting from anoxia 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 4. To prevent blocked airway, resulting from seizure activity

3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 3 The nurse administers 100 percent oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles.

The nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a Mini-Mental Status Examination? 1. To rule out bipolar disorder 2. To rule out schizophrenia 3. To rule out a neurocognitive disorder (NCD) 4. To rule out a personality disorder

3. To rule out a neurocognitive disorder (NCD) A Mini-Mental Status Examination should be performed to rule out an NCD. Memory loss, confused thinking, or apathy may actually be the result of depression. This is often referred to as pseudodementia

A client diagnosed with MDD states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which statement by the nurse best assesses this client's affective symptoms? 1. "Have you been diagnosed with any physical disorder within the past 3 months?" 2. "Have you ever felt this way before? 3. "People who have mood changes often feel better when spring comes." 4. "Help me understand what you mean when you say 'feeling down'."

4. "Help me understand what you mean when you say 'feeling down'."

19. A staff nurse is counseling a depressed client. The nurse determines that the client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives? 1. "It's all my fault for trusting him." 2. "I don't play games. I never win." 3. "She never visits, because she thinks I don't care." 4. "I don't have a green thumb. Any old fool can grow a rose."

4. "I don't have a green thumb. Any old fool can grow a rose." Examples of automatic thoughts in depression include discounting positives; for example, "The other questions were so easy. Any dummy could have gotten them right."

Electroconvulsive therapy (ECT) is considered the treatment of choice for which client? 1. A 39-year-old man experiencing recurrent suicidal ideation 2. A 23-year-old woman experiencing postpartum depression 3. A 41-year-old woman describing a suicide plan 4. A 67-year-old man explaining a recent suicide attempt

4. A 67-year-old man explaining a recent suicide attempt Research has identified ECT as generally safe for acute treatment of late-life depression and may be considered the treatment of choice for the elderly individual who is at acute suicidal risk or unable to tolerate antidepressant medications

The nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Fluoxetine (Prozac)

4. Fluoxetine (Prozac)

Which of the following is considered a predisposing factor for depression? 1. Decreased serum cortisol levels 2. Decreased thyroid function 3. Decreased sodium levels 4. Genetic factors

4. Genetic factors Twin studies suggest a strong genetic factor in the etiology of affective illness, including depressive disorders and bipolar disorders. 2. This is incorrect. Hypothyroidism may mimic symptoms of depression; laboratory testing to evaluate TSH (thyroid-stimulating hormone) levels is relevant to distinguish between depressive disorders and thyroid disorders. The client would be treated with thyroid hormones instead of antidepressants.

A client is diagnosed with persistent depressive disorder (PDD) (dysthymia). Which should the nurse classify as an affective symptom of this disorder? 1. Social isolation with a focus on self 2. Low energy level 3. Difficulty concentrating 4. Gloomy and pessimistic outlook on life

4. Gloomy and pessimistic outlook on life 1. This is incorrect. Social isolation is a behavioral symptom. 2. This is incorrect. This is a physiological symptom of depression. 3. This is incorrect. Difficulty concentrating is a cognitive symptom. 4. This is correct. Symptoms of depression can be described as alterations in four areas of human functions: affective, behavioral, cognitive, and physiological. A gloomy and pessimistic outlook on life is an affective symptom of dysthymia. Affective symptoms are those that relate to the mood.

15. An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? 1. Neuroleptic malignant syndrome; caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) 2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) 3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI 4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs The nurse should suspect that the client is suffering from serotonin syndrome; possibly caused by ingesting two different SSRI's (sertraline and paroxetine). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.

2. When planning care for a depressed client, which correctly written outcome should be a nurse's first priority? 1. The client will promise not to physically harm self. 2. The client will discuss feelings with staff and family by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during hospital stay.

4. The client will remain safe during hospital stay. The nurse's first priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's first priority.

The nurse is reviewing the provider's orders for a client experiencing acute psychosis. The client's family tells the nurse the client has allergies to penicillin, prochlorperazine, and bee stings. Which medication order should the nurse question? 1. Haloperidol 5 mg intramuscularly every 4 hours as needed 2. Clozapine 150 mg PO twice daily 3. Risperidone 2 mg PO twice daily 4. Thioridazine 100 mg PO three times daily

4. Thioridazine 100 mg PO three times daily Prochlorperazine and thioridazine are both classified as phenothiazines. They are contraindicated because there is cross-sensitivity among phenothiazines.

The nurse is caring for four clients taking various medications, including imipramine (Tofranil), doxepin (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? 1. Imipramine (Tofranil) 2. Doxepin (Sinequan) 3. Ziprasidone (Geodon) 4. Tranylcypromine (Parnate)

4. Tranylcypromine (Parnate)

Which nursing action is most appropriate to establish trust with a suspicious client? 1. Maintain consistent staff assignments. 2. Reinforce and focus on reality. 3. Maintain low environmental stimuli. 4. Use a passive communication approach.

4. Use a passive communication approach. 4. This is correct. Use of passive communication is a patient-centered approach that helps establish trust and allows the patient the opportunity to make his or her decisions about activities and treatment goals. 1. This is incorrect. Use of passive communication is a patient-centered approach that helps establish trust and allows the patient the opportunity to make his or her decisions about activities and treatment goals. Consistency in staff also helps develop trust and decrease anxiety, but passive communication is most appropriate. 2. This is incorrect. Use of passive communication is a patient-centered approach that helps establish trust and allows the patient the opportunity to make his or her decisions about activities and treatment goals. Reinforcing and focusing on reality discourages ruminations on illogical thinking. 3. This is incorrect. Use of passive communication is a patient-centered approach that helps establish trust and allows the patient the opportunity to make his or her decisions about activities and treatment goals. Maintaining a low level of environmental stimuli helps decrease anxiety.

Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? Select all that apply. A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

ANS: A, B, D, E +The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part in rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort.

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? Select all that apply. A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations

ANS: A, C, E The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms.

During an admission assessment, a nurse asks a client diagnosed with schizophrenia, Have you ever felt that certain objects or persons have control over your behavior? The nurse is assessing for which type of thought disruption? A. Delusions of persecution B. Delusions of influence C. Delusions of reference D. Delusions of grandeur

ANS: B The nurse is assessing the client for delusions of influence when asking if the client has ever felt that objects or persons have control of the clients behavior. Delusions of control or influence are manifested when the client believes that his or her behavior is being influenced. An example would be if a client believes that a hearing aid receives transmissions that control personal thoughts and behaviors.

A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the clients focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion

ANS: B The nurse should focus on the clients feelings rather than attempt to change the clients delusional thinking by the use of evidence or logical explanations. Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational.

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this clients safety? A. Assess for medication noncompliance B. Note escalating behaviors and intervene immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

ANS: B The nurse should note escalating behaviors and intervene immediately to maintain this clients safety. Early intervention may prevent an aggressive response and keep the client and others safe.

A nurse is caring for a client who is experiencing a flat affect, paranoia, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the clients positive and negative symptoms of schizophrenia? A. Paranoia, anhedonia, and anergia are positive symptoms of schizophrenia. B. Paranoia, neologisms, and echolalia are positive symptoms of schizophrenia. C. Paranoia, anergia, and echolalia are negative symptoms of schizophrenia. D. Paranoia, flat affect, and anhedonia are negative symptoms of schizophrenia.

ANS: B The nurse should recognize that positive symptoms of schizophrenia include paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a decrease or loss of normal functions.

A college student has quit attending classes, isolates self because of hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood

ANS: B The nursing diagnosis that must be prioritized in this situation is risk for other-directed violence R/T yelling accusations. Hearing voices and yelling accusations indicate a potential for violence, and this potential safety issue should be prioritized.

A newly admitted client has taken thioridazine (Mellaril) for 2 years, with good symptom control. Symptoms exhibited on admission included paranoia and hallucinations. The nurse should recognize which potential cause for the return of these symptoms? A. The client has developed tolerance to the antipsychotic medication. B. The client has not taken the medication with food. C. The client has not taken the medication as prescribed. D. The client has combined alcohol with the medication.

ANS: C Altered thinking can affect a clients insight into the necessity for taking antipsychotic medications consistently. When symptoms are no longer bothersome, clients may stop taking medications that cause disturbing side effects. Clients may miss the connection between taking the medications and an improved symptom profile.

A client diagnosed with schizophrenia states, Cant you hear him? Its the devil. Hes telling me Im going to hell. Which is the most appropriate nursing reply? A. Did you take your medicine this morning? B. You are not going to hell. You are a good person. C. Im sure the voices sound scary. I dont hear any voices speaking. D. The devil only talks to people who are receptive to his influence.

ANS: C The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination.

Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply? A. Tell him to stop discussing the voices. B. Ignore what he is saying, while attempting to discover the underlying cause. C. Focus on the feelings generated by the hallucinations and present reality. D. Present objective evidence that the voices are not real.

ANS: C The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content. It is inappropriate to present logical arguments to persuade the client to accept the hallucinations as not real.

An elderly client diagnosed with schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, the nurse would most appropriately make which statement? A. Make sure you concentrate on taking slow, deep, cleansing breaths. B. Watch your diet and try to engage in some regular physical activity. C. Rise slowly when you change position from lying to sitting or sitting to standing. D. Wear sunscreen and try to avoid midday sun exposure.

ANS: C The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension.

A client diagnosed with schizophrenia states, My psychiatrist is out to get me. Im sad that the voice is telling me to stop him. What symptom is the client exhibiting, and what is the nurses legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication B. Persecutory delusions; orient the client to reality C. Command hallucinations; warn the psychiatrist D. Altered thought processes; call an emergency treatment team meeting

ANS: C The nurse should determine that the client is exhibiting command hallucinations. The nurses legal responsibility is to warn the psychiatrist of the potential for harm. A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self.

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

ANS: C The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol), 50 mg bid; benztropine (Cogentin), 1 mg prn; and zolpidem (Ambien), 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

A nurse is assessing a client diagnosed with schizophrenia. The nurse asks the client, Do you receive special messages from certain sources, such as the television or radio? Which potential symptom of this disorder is the nurse assessing? A. Thought insertion B. Paranoia C. Magical thinking D. Delusions of reference

ANS: D The nurse is assessing for the potential symptom of delusions of reference. A client who believes that he or she receives messages through the radio is experiencing delusions of reference. When a client experiences these delusions, he or she interprets all events within the environment as personal references.

A client diagnosed with schizophrenia, who has been taking antipsychotic medication for the last 5 months, presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome, treated by discontinuing antipsychotic medications B. Agranulocytosis, treated by administration of clozapine (Clozaril) C. Extrapyramidal symptoms, treated by administration of benztropine (Cogentin) D. Tardive dyskinesia, treated by discontinuing antipsychotic medications

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

The nurse should frequently assess a client with a depressive disorder for lethality risk related to suicidal ideation. Which questions should the nurse include? Select all that apply. 1. "Are you thinking about hurting yourself or someone else?" 2. "Can you tell me your feelings about dying?" 3. "Where do you keep your gun?" 4. "Have you told your psychiatrist you feel like dying?" 5. "Have you thought about how you would hurt yourself?"

1. "Are you thinking about hurting yourself or someone else?" 3. "Where do you keep your gun?" 5. "Have you thought about how you would hurt yourself?"

A 16-year-old client diagnosed with schizophrenia is experiencing auditory command hallucinations. The client reports the voices are telling him to harm others. The client's parents ask the nurse, "Where do the voices come from?" Which is the nurse's most appropriate reply? 1. "Auditory hallucinations are caused by increased dopamine levels in the brain." 2. "Hallucinations can be caused by medication interactions." 3. "Hallucinations occur when there is not enough serotonin in the brain." 4. "Auditory hallucinations are mainly due to abnormal hormonal changes."

1. "Auditory hallucinations are caused by increased dopamine levels in the brain." Hallucinations are false sensory perceptions not associated with real external stimuli and may involve any of the five senses. Hallucinations are positive symptoms of schizophrenia related to increased production or release of dopamine at nerve terminals. Antipsychotic medications reduce psychotic symptoms by lowering brain levels of dopamine.

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? 1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." 2. "Clozapine (Clozaril) is used off-label for the long-term treatment of panic disorder." 3. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks." 4. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." The benzodiazepines alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin) have been particularly effective in the treatment of panic disorder. They can be prescribed on an as-needed basis when the client is feeling particularly anxious. Benzodiazepines such as clonazepam can be abused and lead to physical dependence and tolerance. 2. This is incorrect. Clozapine (Clozaril) is an atypical antipsychotic used to treat symptoms of schizophrenia and psychosis. 3. This is incorrect. Doxepin (Sinequan) is a tricyclic antidepressant. 4. This is incorrect. Buspirone (BuSpar) is used to treat GAD and has the benefit of lack of physical dependence and tolerance.

Which condition appears to have a connection to bipolar disorder in youth? 1. Attention deficit-hyperactivity disorder (ADHD) 2. Disruptive mood dysregulation disorder 3. Nonepisodic irritability 4. Schizophrenia

1. Attention deficit-hyperactivity disorder (ADHD)

A client presents in the emergency department with complaints of overwhelming anxiety. Which of the following is the priority nursing assessment? 1. Suicide risk 2. Cardiac status 3. Current stressors 4. Substance use history

2. Cardiac status The nursing priority is to evaluate cardiac status. MI and CHF can be life threatening. Symptoms of anxiety often mimic those of an MI

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the nurse's most appropriate reply? 1. "I know it's frightening, but try to remind yourself that it will only last a short time." 2. "Death from a panic attack happens so infrequently that there is no need to worry." 3. "Most people who experience panic attacks have feelings of impending doom." 4. "Tell me why you think you are going to die every time you have a panic attack."

1. "I know it's frightening, but try to remind yourself that it will only last a short time." The nurse's most appropriate reply is to empathize with the client and provide encouragement that panic attacks last only a short period. Clients experiencing a panic attack often fear that they are dying and experience intense physical discomfort. The physical sensations can be so intense that the individual believes they are having a heart attack or other critical illness. Symptoms of depression are common with this disorder

The nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement indicates a need for further instructions? 1. "I will need scheduled bloodwork to monitor for toxic levels of this drug." 2. "I won't stop taking this medication abruptly, because there could be serious complications." 3. "I will not drink alcohol while taking this medication." 4. "I won't take extra doses of this drug because I can become addicted."

1. "I will need scheduled bloodwork to monitor for toxic levels of this drug."

A client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to the nurse that discharge teaching about this medication has been successful? Select all that apply. 1. "I'll have to let my surgeon know about this medication before surgery." 2. "Guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food and medication labels." 4. "I'm going to limit my water intake." 5. "I'll be sure not to stop this medication abruptly."

1. "I'll have to let my surgeon know about this medication before surgery." 2. "Guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food and medication labels." 5. "I'll be sure not to stop this medication abruptly."

A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following responses by the nurse are accurate? Select all that apply. 1. "Some antianxiety agents have been successful in treating social phobias." 2. "Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia)." 3. "Specific phobias are generally not treated with medication unless accompanied by panic attacks." 4. "Beta blockers have been used successfully to treat phobic responses to public performance." 5. "Medications are not the preferred treatment for phobic disorders. One would exhaust all non-medication treatments first."

1. "Some antianxiety agents have been successful in treating social phobias." 2. "Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia)." 3. "Specific phobias are generally not treated with medication unless accompanied by panic attacks." 4. "Beta blockers have been used successfully to treat phobic responses to public performance." 1. This is correct. The benzodiazepines have been successful in the treatment of social anxiety disorder (social phobia). 2. This is correct. The tricyclic imipramine and the monoamine oxidase inhibitor phenelzine have been effective in diminishing symptoms of agoraphobia and social anxiety disorder. 3. This is correct. Specific phobias are generally not treated with medication unless panic attacks accompany the phobia. 4. This is correct. Several studies have called attention to the effectiveness of beta blockers (e.g., propranolol) and alpha2-receptor agonists (e.g., clonidine) in the amelioration of anxiety symptoms (Bhatt, 2016). Propranolol has potent effects on the somatic manifestations of anxiety (e.g., palpitations, tremors), with less dramatic effects on the psychic component of anxiety. 5. This is incorrect. There are non-medication approaches to treating phobic disorders, however, not all other approaches are exhausted before using medication

The nurse understands psychotic postpartum depression is characterized by which symptoms? Select all that apply. 1. Agitation 2. Fear the infant will be harmed 3. Loss of libido 4. Guilt 5. Sleep disturbances

1. Agitation 2. Fear the infant will be harmed 4. Guilt

A client has a history of excessive fear of water. Which term should the nurse use to describe this specific phobia, and under what subtype is this phobia identified? 1. Aquaphobia; a natural environment type of phobia 2. Aquaphobia; a situational type of phobia 3. Acrophobia; a natural environment type of phobia 4. Acrophobia; a situational type of phobia

1. Aquaphobia; a natural environment type of phobia

A client diagnosed with bipolar disorder states, "I hate oatmeal. Let's get everybody together to do exercises. I'm thirsty and I'm burning up. Get out of my way; I have to see that guy." Which is the priority nursing action? 1. Assess the client's vital signs. 2. Offer to have the dietitian discuss food preferences. 3. Encourage the client to lead the exercise program in the community meeting. 4. Acknowledge the client briefly, and then walk away.

1. Assess the client's vital signs.

Which of the following instructions regarding lithium therapy should be included in the nurse's discharge teaching? Select all that apply. 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2500 to 3000 mL of fluid per day. 4. Restrict potassium-containing foods. 5. Take medication on an empty stomach.

1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2500 to 3000 mL of fluid per day.

A client diagnosed with obsessive-compulsive disorder (OCD) reports to the nurse that he can't stop thinking about all the potentially life-threatening germs in the environment. Which is the most accurate way for the nurse to document this symptom? 1. Client is expressing an obsession with germs. 2. Client is manifesting compulsive thinking. 3. Client is expressing delusional thinking about germs. 4. Client is manifesting arachnophobia of germs.

1. Client is expressing an obsession with germs The client is expressing an obsession with germs. Obsessions are unwanted, intrusive, repetitive thoughts. 2. This is incorrect. Compulsions are unwanted, repetitive behavior patterns in response to obsessive thoughts that are efforts to reduce anxiety. 3. This is incorrect. Delusions are false, fixed beliefs. 4. This is incorrect. Arachnophobia is a fear of spiders.

5. Which symptoms should the nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. A client diagnosed with OCD experiences both obsessions and compulsions. Clients with obsessive-compulsive personality disorder exhibit a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, but do not experience obsessions and compulsions.

The nurse has been caring for a client diagnosed with GAD. Which of the following nursing interventions address this client's symptoms? Select all that apply. 1. Encourage the client to recognize the signs of escalating anxiety. 2. Encourage the client to avoid any situation that causes stress. 3. Encourage the client to employ newly learned relaxation techniques. 4. Encourage the client to reframe cognitively thoughts about situations that generate anxiety. 5. Encourage the client to avoid caffeinated products.

1. Encourage the client to recognize the signs of escalating anxiety. 3. Encourage the client to employ newly learned relaxation techniques. 4. Encourage the client to reframe cognitively thoughts about situations that generate anxiety. 5. Encourage the client to avoid caffeinated products. 2. This is incorrect. Encouraging the client to avoid situations that cause stress is not an appropriate intervention, because avoidance does not help the client overcome anxiety. Stress is a component of life and is not easily evaded. Appropriate nursing interventions that address GAD symptoms include encouraging the client to recognize signs of escalating anxiety, to employ relaxation techniques, to reframe cognitively thoughts about anxiety-provoking situations, and to avoid caffeinated products.

A college student has been diagnosed with GAD. Which of the following symptoms should a campus nurse expect this client to exhibit? Select all that apply. 1. Fatigue 2. Anorexia 3. Hyperventilation 4. Insomnia 5. Irritability

1. Fatigue 4. Insomnia 5. Irritability A client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry.

A client is prescribed alprazolam (Xanax) for acute anxiety. Which client history should cause the nurse to question this order? 1. History of alcohol dependence 2. History of personality disorder 3. History of schizophrenia 4. History of hypertension

1. History of alcohol dependence Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. Clients with a history of substance abuse are more likely to abuse other addictive substances and/or combine this drug with alcohol.

Nursing care of a client with a diagnosis of substance-induced anxiety disorder must take into consideration the nature of the substance and if the symptoms are in the context of which of the following? Select all that apply. 1. Intoxication. 2. Psychosocial needs. 3. Previous exposure. 4. Withdrawal.

1. Intoxication. 4. Withdrawal. The diagnosis of substance-induced anxiety disorder is made only if the anxiety symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and warrant independent clinical attention

A client who has been diagnosed with bipolar I disorder states, "God has taught me how to decode the Bible." The nurse should anticipate which combination of medications would be ordered to address this client's symptoms? 1. Lithium carbonate (Lithobid) and risperidone (Risperdal) 2. Lithium carbonate (Lithobid) and carbamazepine (Tegretol) 3. Valproic acid (Depakote) and sertraline (Zoloft) 4. Valproic acid (Depakote) and lamotrigine (Lamictal)

1. Lithium carbonate (Lithobid) and risperidone (Risperdal) The nurse should anticipate lithium carbonate (Lithobid) and risperidone (Risperdal) to be ordered. Lithium carbonate is a mood stabilizer, and risperidone is an atypical antipsychotic. Risperidone will address the client's symptoms of psychosis (delusions of grandeur) and has sedative effects to reduce symptoms of agitation, hyperactivity, and/or insomnia. Lithium takes 1 to 3 weeks to take its full effect

A client and a nurse therapist are developing a treatment plan that includes strategies to manage bipolar disorder. Which should be included? Select all that apply. 1. Maintain a consistent sleep schedule. 2. Become an expert on the disorder. 3. Create a daily medication schedule. 4. Set a time frame to achieve remission. 5. Develop an emergency plan.

1. Maintain a consistent sleep schedule. 2. Become an expert on the disorder. 3. Create a daily medication schedule. 5. Develop an emergency plan.

24. An attractive female client presents with high anxiety levels because of her belief that her facial features are large and grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this diagnosis? (Select all that apply.) 1. Mirror checking 2. Excessive grooming 3. History of an eating disorder 4. History of delusional thinking 5. Skin picking

1. Mirror checking 2. Excessive grooming 5. Skin picking

The clinic nurse is reviewing the medication list of a client diagnosed with medication-induced bipolar disorder. The nurse recognizes which may have precipitated the client's mood disturbance? Select all that apply. 1. Oral contraceptives 2. Antihypertensives 3. Dopamine agonists 4. Corticosteroids 5. Alpha-adrenergics

1. Oral contraceptives 2. Antihypertensives 4. Corticosteroids

A client is diagnosed with bipolar I disorder: manic episode. Which nursing intervention should be implemented to achieve the outcome of "Client will gain 2 lb by the end of the week?" 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate parenteral nutrition (PN) to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

1. Provide client with high-calorie finger foods throughout the day.

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. Which should be the priority nursing diagnosis for this client? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

1. Risk for suicide R/T hopelessness

A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.) 1. Sad mood on most days 2. Mood rating of 2 out of 10 for the past 6 months 3. Labile mood 4. Sad mood for the past 3 years after spouse's death 5. Pressured speech when communicating

1. Sad mood on most days 4. Sad mood for the past 3 years after spouse's death

A client is diagnosed with persistent depressive disorder (PDD) (dysthymia). Which should the nurse classify as an behavioral symptom of this disorder? 1. Social isolation with a focus on self 2. Low energy level 3. Difficulty concentrating 4. Gloomy and pessimistic outlook on life

1. Social isolation with a focus on self

A 20-year-old female has a diagnosis of PMDD. Which of the following should the nurse identify as consistent with this diagnosis? Select all that apply. 1. Symptoms are causing significant interference with daily activities. 2. Client-rated mood is 2/10 for the past 6 months. 3. Mood swings occur the week before onset of menses. 4. Client reports subjective difficulty concentrating. 5. Client manifests pressured speech when communicating.

1. Symptoms are causing significant interference with daily activities. 3. Mood swings occur the week before onset of menses. 4. Client reports subjective difficulty concentrating.

A nursing instructor is teaching about the new DSM-5 diagnostic category of disruptive mood dysregulation disorder (DMDD). Which of the following information should the instructor include? (Select all that apply.) 1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested only behaviorally. 5. Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.

1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts.

Which of the following explanations should the nurse include when teaching parents why it is difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? Select all that apply. 1. Symptoms of bipolar disorder are similar to those of attention deficit-hyperactivity disorder. 2. Children are naturally active, energetic, and spontaneous. 3. Neurotransmitter levels vary considerably in accordance with age. 4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18 years. 5. Genetic predisposition is not a reliable diagnostic determinant

1. Symptoms of bipolar disorder are similar to those of attention deficit-hyperactivity disorder. 2. Children are naturally active, energetic, and spontaneous.

The nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, "You can't do this to me. Do you know who I am?" Which is the priority nursing action in this situation? 1. To provide self and client with a safe environment 2. To redirect the client to the needed assessment information 3. To provide high-calorie finger foods to meet nutritional needs 4. To reorient the client to person, place, time, and situation

1. To provide self and client with a safe environment

Order the depressive disorders and their predominant affective symptoms according to level of severity. ________ Dysthymic disorder (pessimistic outlook, low self-esteem) ________ Grief (feelings of anger, anxiety, guilt, helplessness) ________ Major depressive episode (despair, worthlessness, flat affect, apathy, anhedonia) ________ Transient depression (sadness, dejection, feeling downhearted, having "the blues")

1. Transient depression (sadness, dejection, feeling downhearted, having "the blues") 2. Grief (feelings of anger, anxiety, guilt, helplessness) 3. Dysthymic disorder (pessimistic outlook, low self-esteem) 4. Major depressive episode (despair, worthlessness, flat affect, apathy, anhedonia)

A client is admitted in a manic episode of bipolar I disorder. Which nursing intervention is most therapeutic for this client? 1. Use a calm, unemotional approach during client interactions. 2. Focus primarily on enforcing limits. 3. Limit interactions to decrease external stimuli. 4. Encourage the client to establish social relationships with peers

1. Use a calm, unemotional approach during client interactions.

A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything. The family member asks, "Should I seek psychiatric help for my mother?" Which is the nurse's most appropriate reply? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning."

A client's spouse asks, "What evidence supports the possibility of genetic transmission of bipolar disorder?" Which is the best nursing reply? 1. "Clients diagnosed with bipolar disorders have alterations in neurochemicals that affect behaviors." 2. "Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder." 3. "Higher rates of relatives of clients diagnosed with bipolar disorder respond in an exaggerated way to daily stress." 4. "More individuals diagnosed with bipolar disorder come from higher socioeconomic and educational backgrounds."

2. "Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder."

Which client statement indicates to the nurse that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment? 1. "I will limit my intake of fluids daily." 2. "I will maintain normal salt intake." 3. "I will take Lithobid on an empty stomach." 4. "I will increase my caloric intake to prevent weight loss."

2. "I will maintain normal salt intake."

After teaching a client about lithium carbonate (Lithane), the nurse would conclude teaching was successful based on which client statement? 1. "I should expect to feel better in a couple of days." 2. "I'll call my doctor immediately if I experience any diarrhea or ringing in my ears." 3. "If I forget a dose, I can double the dose the next time I take this drug." 4. "I need to restrict my intake of any food containing salt."

2. "I'll call my doctor immediately if I experience any diarrhea or ringing in my ears."

The nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement provides supportive evidence of this symptom? 1. "I can't stop my sexual urges. They have led me to numerous affairs." 2. "I'm the world's most perceptive attorney." 3. "My spouse is distraught about my overspending." 4. "The Federal Bureau of Investigation (FBI) is out to get me."

2. "I'm the world's most perceptive attorney."

A nursing student questions an instructor regarding the order for fluvoxamine (Luvox), 300 mg daily, for a client diagnosed with OCD. Which instructor reply is most accurate? 1. "High doses of tricyclic medications will be required for effective treatment of OCD." 2. "SSRI doses, more than what is effective for treating depression, may be required for OCD." 3. "The dose of fluvoxamine (Luvox) is low due to the side effect of daytime drowsiness and nighttime insomnia." 4. "The dosage of fluvoxamine (Luvox) is outside the therapeutic range and needs to be questioned."

2. "SSRI doses, more than what is effective for treating depression, may be required for OCD." SSRI doses higher than what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the FDA for the treatment of OCD. Common side effects include headache, sleep disturbances, and restlessness.

A nursing instructor is teaching about specific phobias. Which student statement indicates that learning has occurred? 1. "These clients do not recognize that their fear is excessive, and they rarely seek treatment." 2. "These clients have overwhelming symptoms of panic when exposed to the phobic stimulus." 3. "These clients experience symptoms that mirror a cerebrovascular accident (CVA)." 4. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

2. "These clients have overwhelming symptoms of panic when exposed to the phobic stimulus."

A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates learning has occurred? 1. "This disorder is more prevalent in lower socioeconomic groups." 2. "This disorder is more prevalent in higher socioeconomic groups." 3. "This disorder is equally prevalent in all socioeconomic groups." 4. "This disorder is unpredictable based on socioeconomic groups."

2. "This disorder is more prevalent in higher socioeconomic groups."

A client refuses to go on a cruise to the Bahamas with his spouse because of fearing that the cruise ship will sink and all aboard will drown. Using a cognitive theory perspective, the nurse should use which of these statements to explain the etiology of this fear to his spouse? 1. "Your spouse may be unable to resolve internal conflicts, which result in projected anxiety." 2. "Your spouse may be experiencing a distorted and unrealistic appraisal of the situation." 3. "Your spouse may have a genetic predisposition to overreacting to potential danger." 4. "Your spouse may have high levels of brain chemicals that may distort thinking."

2. "Your spouse may be experiencing a distorted and unrealistic appraisal of the situation." Using a cognitive perspective, the nurse should explain that the client is experiencing a distorted and unrealistic appraisal of the situation and that fear can be described as the result of faulty cognitions.

A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. Which lithium level should the nurse correlate with these symptoms? 1. 1.3 meq/L 2. 1.7 meq/L 3. 2.3 meq/L 4. 3.7 meq/L

2. 1.7 meq/L The client's symptoms are correlated with a lithium level of 1.7 meq/L. The therapeutic level of lithium carbonate is 1.0 to 1.5 meq/L for acute mania and 0.6 to 1.2 meq/L for maintenance therapy. Symptoms of lithium toxicity include persistent nausea and vomiting, severe diarrhea, ataxia, blurred vision, tinnitus, excessive urine output, increasing tremors, and mental confusion. Lithium toxicity can lead to renal failure and death.

A client diagnosed with bipolar I disorder is distraught over insomnia experienced over the past 3 nights and a 12-lb weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? 1. Knowledge deficit related to (R/T) bipolar disorder as evidenced by (AEB) concern about symptoms 2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3. Risk for suicide R/T powerlessness AEB insomnia and anorexia 4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss

Which carries a warning label stating that the use of the medication increases risk for suicidal thoughts and behaviors? 1. Antipsychotics 2. Antiepileptics 3. Mood stabilizers 4. Anxiolytics

2. Antiepileptics

In which way can anxiety be distinguished from fear? 1. Anxiety involves the intellectual appraisal of a threatening stimulus. 2. Anxiety is an emotional process while fear is a cognitive one. 3. Fear involves the emotional response to the appraisal of anxiety. 4. Anxiety results from a specific or known threat.

2. Anxiety is an emotional process while fear is a cognitive one. Fear is a cognitive process while anxiety is an emotional process.

12. A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech and flight of ideas. Based on this symptom change, which physician action would the nurse anticipate? 1. Increase the dosage of fluoxetine. 2. Discontinue the fluoxetine and rethink the client's diagnosis. 3. Order benztropine (Cogentin) to address extrapyramidal symptoms. 4. Order olanzapine (Zyprexa) to address altered thoughts.

2. Discontinue the fluoxetine and rethink the client's diagnosis. A full manic episode emerging during antidepressant treatment (medication, electroconvulsive therapy, etc.), but persisting beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis. It would be inappropriate to increase the dosage of fluoxetine.

A client has the following symptoms: preoccupation with imagined defect, verbalizations that are out of proportion to actual physical abnormalities, and numerous visits to plastic surgeons to seek relief. Which nursing diagnosis best describes the problems evidenced by these symptoms? 1. Ineffective coping 2. Disturbed body image 3. Complicated grieving 4. Panic anxiety

2. Disturbed body image The client's symptoms are characteristic of BMD; therefore, "disturbed body image" best describes the client's symptoms. DSM-5 criteria for BMD include (a) preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others and (b) the individual has performed repetitive behaviors in response to the appearance concerns at some point during the course of the disorder.

An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should the nurse identify as most likely to contribute to the etiology of these symptoms? Select all that apply. 1. Gender differences in social opportunities that occur with age 2. Drastic temperature and barometric pressure changes 3. Increased levels of melatonin 4. Variations in serotonergic functioning 5. Inaccessibility of resources for dealing with life stressors

2. Drastic temperature and barometric pressure changes 3. Increased levels of melatonin 4. Variations in serotonergic functioning

13. Which is the basic premise of a recovery model used to treat clients diagnosed with bipolar disorder? 1. Medication adherence 2. Empowerment of the consumer 3. Total absence of symptoms 4. Improved psychosocial relationships

2. Empowerment of the consumer The basic premise of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care and to enable a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

A newly admitted client is diagnosed with bipolar disorder: manic episode. Which symptom related to altered thought is the nurse most likely to find on assessment? 1. Pacing 2. Flight of ideas 3. Lability of mood 4. Irritability

2. Flight of ideas

The nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral therapies to be most commonly used in the treatment of phobias? Select all that apply. 1. Benzodiazepine therapy 2. Systematic desensitization 3. Imploding (flooding) 4. Assertiveness training 5. Aversion therapy

2. Systematic desensitization 3. Imploding (flooding)

A client is taking chlordiazepoxide (Librium) for GAD symptoms. In which situation should the nurse recognize that this client is at greatest risk for drug overdose? 1. The client has a knowledge deficit related to the effects of the drug. 2. The client combines the drug with alcohol. 3. The client takes the drug on an empty stomach. 4. The client fails to follow dietary restrictions.

2. The client combines the drug with alcohol.

A client is diagnosed with cyclothymic disorder. Which client behaviors should the nurse expect to find on assessment? 1. The client expresses "feeling blue most of the time." 2. The client has endured periods of elation and dysphoria for more than 2 years. 3. The client continually fixates on hopelessness and thoughts of suicide. 4. The client has labile moods with periods of acute mania.

2. The client has endured periods of elation and dysphoria for more than 2 years.

A client diagnosed with OCD is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which should be the initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day 3. 4. The client will substitute a productive activity for rituals by day 1.

2. The client will wake early enough to complete rituals prior to breakfast. The appropriate initial client outcome would be for the client to wake early enough to complete rituals prior to breakfast. The nurse should also provide a structured schedule of activities and, later in treatment, gradually begin to limit the time allowed for rituals. 1. This is incorrect. Later in treatment, the goal is to gradually begin to limit the time allowed for rituals. 3. This is incorrect. The appropriate initial client outcome would be for the client to wake early enough to complete rituals prior to breakfast. Participating in three unit activities by day 3 does not address the coping improvements needed. The nurse should also provide a structured schedule of activities and, later in treatment, gradually begin to limit the time allowed for rituals. 4. This is incorrect. The client cannot be expected to eliminate the ritual activities within one day.

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Trazodone (Desyrel) 4. Paroxetine (Paxil)

2. Valproic acid (Depakote)

A client living on the beachfront seeks help with an extreme fear of crossing bridges, which interferes with daily life. A psychiatric-mental health nurse practitioner decides to try systematic desensitization. Which explanation of this therapy should the nurse convey to the client? 1. "Using your imagination, we will attempt to achieve a state of relaxation that you can replicate when faced with crossing a bridge." 2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety."

A college student is unable to take a final examination because of severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which is the priority nursing diagnosis that the campus nurse should assign for this client? 1. Noncompliance related to (R/T) test taking 2. Ineffective role performance R/T helplessness 3. Altered coping R/T anxiety 4. Powerlessness R/T fear

3. Altered coping R/T anxiety

A client on an inpatient unit is diagnosed with bipolar disorder: manic episode. During a discussion in the dayroom about weekend activities, the client raises his voice, becomes irritable, and insists that plans change. Which should be the nurse's initial intervention? 1. Ask the group to take a vote on alternative weekend events. 2. Remind the client to quiet down or leave the dayroom. 3. Assist the client to move to a calmer location. 4. Discuss impulse control problems with the client.

3. Assist the client to move to a calmer location.

3. How would the nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)? 1. Clients diagnosed with social phobia can manage anxiety without medications, whereas clients diagnosed with SPD can manage anxiety only with medications. 2. Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social phobia are not. 3. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. 4. Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social phobias tend to avoid interactions in all areas of life.

3. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.

How would the nurse best describe the major maladaptive client response to panic disorder? 1. Clients overuse medical care because of physical symptoms. 2. Clients use illegal drugs to ease symptoms. 3. Clients perceive having no control over life situations. 4. Clients develop compulsions to deal with anxiety.

3. Clients perceive having no control over life situations. The major maladaptive client response to panic disorder is the perception of having no control over life situations, which leads to nonparticipation in decision-making and doubts regarding role performance

A client is diagnosed with persistent depressive disorder (PDD) (dysthymia). Which should the nurse classify as an cognitive symptom of this disorder? 1. Social isolation with a focus on self 2. Low energy level 3. Difficulty concentrating 4. Gloomy and pessimistic outlook on life

3. Difficulty concentrating

11. A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode? 1. During a manic episode, clients may experience an inflated self-esteem or grandiosity, and these symptoms are absent in hypomania. 2. During a manic episode, clients may experience a decreased need for sleep, and this symptom is absent in hypomania. 3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. 4. During a manic episode, clients may experience flight of ideas and racing thoughts, and these symptoms are absent in hypomania.

3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. Three or more of the following symptoms may be experienced in both hypomanic and manic episodes: Inflated self-esteem or grandiosity, decreased need for sleep (e.g., feels rested after only 3 hours of sleep), more talkative than usual or pressure to keep talking, flight of ideas and racing thoughts, distractibility, increase in goaldirected activity (either socially, at work or school, or sexually) or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments). If there are psychotic features, the episode is, by definition, manic.

10. A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1. Teach deep breathing relaxation exercises. 2. Place the client in a Trendelenburg position. 3. Have the client breathe into a paper bag. 4. Administer the ordered prn buspirone (BuSpar).

3. Have the client breathe into a paper bag.

19. During her aunt's wake, a 4-year-old child runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? 1. Complicated grieving 2. Altered family processes 3. Ineffective coping 4. Body image disturbance

3. Ineffective coping

Which treatment should the nurse identify as most appropriate for clients diagnosed with GAD? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with citalopram (Celexa) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

3. Long-term treatment with buspirone (BuSpar) Buspirone (BuSpar) is an anxiolytic medication that is the drug of choice for treatment of GAD. Buspirone is effective in 60% to 80% of clients with GAD and takes 10 to 14 days for alleviation of symptoms; it does not have the physical dependency or tolerance effects of other anxiolytics

The nurse is planning care for a client diagnosed with bipolar disorder: manic episode. Which should be the first priority of the listed client outcomes? 1. Maintains nutritional status 2. Interacts appropriately with peers 3. Remains free from injury 4. Sleeps 6 to 8 hours per night

3. Remains free from injury

A newly admitted client is experiencing a manic episode of bipolar I disorder and presents as very agitated. The nurse should assign which priority nursing diagnosis to this client? 1. Ineffective individual coping R/T hospitalization AEB alcohol abuse 2. Altered nutrition: less than body requirements R/T mania AEB weight loss 3. Risk for violence: directed toward others R/T agitation and hyperactivity 4. Sleep pattern disturbance R/T flight of ideas AEB sleeping 1 to 2 hours per night

3. Risk for violence: directed toward others R/T agitation and hyperactivity

Warren's college roommate actively resists going out with friends whenever they invite him. He says he can't stand to be around other people and confides to Warren "They wouldn't like me anyway." Which disorder is Warren's roommate likely suffering from? 1. Agoraphobia 2. Mysophobia 3. Social anxiety disorder 4. Panic disorder

3. Social anxiety disorder Social anxiety disorder is an excessive fear of social situations related to fear that one might do something embarrassing or be evaluated negatively by others.

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's immediate need? 1. Teach deep-breathing relaxation exercises. 2. Place the client in a Trendelenburg position. 3. Stay with the client and offer reassurance of safety. 4. Administer the ordered PRN buspirone (BuSpar).

3. Stay with the client and offer reassurance of safety

A client diagnosed with generalized anxiety disorder states, "I know the best thing for me to do now is to just forget my worries." How should the nurse evaluate this statement? 1. The client is developing insight. 2. The client's coping skills are improving. 3. The client has a distorted perception of problem resolution. 4. The client is meeting outcomes and moving toward discharge

3. The client has a distorted perception of problem resolution.

A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client? 1. The client will accomplish activities of daily living (ADLs) independently by discharge. 2. The client will verbalize feelings during group sessions by discharge. 3. The client will remain safe from harm throughout hospitalization. 4. The client will use problem-solving to cope adequately after discharge.

3. The client will remain safe from harm throughout hospitalization.

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood euthymic. Exhibiting magical thinking. Restless." 3. "Mood labile. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

The psychiatric-mental health nurse is providing discharge teaching for a client diagnosed with bipolar disorder. Which statement indicates that the nurse's teaching is effective? 1. "I shouldn't take my lithium when I have the flu." 2. "I am looking forward to having real coffee in the morning." 3. "I can get off medication in 5 years if I am stable." 4. "I'll be the designated driver since I shouldn't have alcohol with lamotrigine."

4. "I'll be the designated driver since I shouldn't have alcohol with lamotrigine."

Which client statement expresses typical underlying feelings of clients diagnosed with MDD? 1. "It's just a matter of time, and I will be well." 2. "If I ignore these feelings, they will go away." 3. "I can fight these feelings and overcome this disorder." 4. "Nothing will help me feel better."

4. "Nothing will help me feel better."

15. The nurse is providing education to a client diagnosed with anxiety. Which statement by the client indicates that teaching has been effective? 1. "There is nothing that I can do to that will reduce anxiety." 2. "Medication is available, but only for those who have had anxiety for a year or more." 3. "If I ignore the symptoms of anxiety, it will go away." 4. "Practicing yoga or meditation may help reduce my anxiety."

4. "Practicing yoga or meditation may help reduce my anxiety."

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? 1. "Treatment is compromised when clients have difficulty sleeping." 2. "Treatment is compromised when irritability interferes with social interactions." 3. "Treatment is compromised when clients have no insight into their problems." 4. "Treatment is compromised when clients choose not to take their medications."

4. "Treatment is compromised when clients choose not to take their medications."

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse questions the Zyprexa order. Which is the appropriate nursing reply? 1. "Zyprexa in combination with Eskalith cures manic symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa ensures a good night's sleep." 4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

How would the nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? 1. GAD is acute in nature, and panic disorder is chronic. 2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. 3. Hyperventilation is a common symptom in GAD and rare in panic disorder. 4. Depersonalization is commonly seen in panic disorder and absent in GAD

4. Depersonalization is commonly seen in panic disorder and absent in GAD 1. This is incorrect. Panic disorder is characterized by recurrent, unpredictable panic attacks. GAD is characterized by persistent, excessive anxiety. 2. This is incorrect. Chest pain is among the physical symptoms that may occur during a panic attack. 3. This is incorrect. Hyperventilation is among the physical symptoms that may occur during a panic attack. 4. This is correct. A client diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety.

A client is newly diagnosed with OCD and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors

4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors If the client is going to be able to avoid the anxiety, he or she must first learn to recognize precipitating factors. 1. This is incorrect. If the client is going to be able to avoid the anxiety, he or she must first learn to recognize precipitating factors. Attempting to distract the client does not help the client recognize anxiety triggers. 2. This is incorrect. If the client is going to be able to avoid the anxiety, he or she must first learn to recognize precipitating factors. Seeking medication dosage increases is not an appropriate intervention because it does not help the client recognize anxiety triggers. 3. This is incorrect. The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. Locking the client's room is not an appropriate intervention because it does not help the client recognize anxiety triggers.

A client diagnosed with OCD spends hours bathing and grooming. During a one-onone interaction, the client discusses the rituals in detail, but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify? 1. Sublimation 2. Dissociation 3. Rationalization 4. Intellectualization

4. Intellectualization The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of OCD in detail while avoiding discussion of feelings. Intellectualization is an attempt to avoid expressing emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis. 1. This is incorrect. The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of OCD disorder in detail while avoiding discussion of feelings. Sublimation involves achieving impulse gratification and the retention of goals but altering a socially objectionable aim or object to a socially acceptable one. 2. This is incorrect. The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of OCD in detail while avoiding discussion of feelings. Dissociation involves temporarily but drastically modifying one's character or sense of personal identity to avoid emotional distress. 3. This is incorrect. The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of OCD in detail while avoiding discussion of feelings. Rationalization involves offering rational explanations to justify attitudes, beliefs, or behavior that may otherwise be unacceptable.

A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive work-up in an emergency department reveals no pathology. Which medical diagnosis is suspected, and which nursing diagnosis is the priority? 1. Generalized anxiety disorder (GAD) and a nursing diagnosis of fear 2. Altered sensory perception and a nursing diagnosis of panic disorder 3. Pain disorder and a nursing diagnosis of altered role performance 4. Panic disorder and a nursing diagnosis of panic anxiety

4. Panic disorder and a nursing diagnosis of panic anxiety The client exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis is panic anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror. 1. This is incorrect. The client exhibited signs and symptoms of a panic disorder rather than GAD. The priority nursing diagnosis is not fear. 2. This is incorrect. The client exhibited signs and symptoms of a panic disorder rather than altered sensory perception. The priority nursing diagnosis is panic anxiety, not panic disorder. 3. This is incorrect. The client exhibited signs and symptoms of a panic disorder rather than a pain disorder. The priority nursing diagnosis is not altered role performance but panic anxiety.

The inpatient psychiatric unit is being redecorated. At a unit meeting, staff discusses bedroom decor for clients experiencing mania. The nurse manager evaluates which suggestion as most appropriate? 1. Rooms should contain extra-large windows with views of the street. 2. Rooms should contain brightly colored walls with printed drapes. 3. Rooms should be painted deep colors and located close to the nurse's station. 4. Rooms should be painted with neutral colors and contain pale-colored accessories.

4. Rooms should be painted with neutral colors and contain pale-colored accessories.

15. A nurse is assessing an adolescent client diagnosed with cyclothymic disorder. Which of the following DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.) 1. Symptoms lasting for a minimum of two years 2. Numerous periods with manic symptoms 3. Possible comorbid diagnosis of a delusional disorder 4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

A client who is admitted to the inpatient psychiatric unit and is taking Thorazine presents to the nurse with severe muscle rigidity, tachycardia, and a temperature of 105F (40.5C). The nurse identifies these symptoms as which of the following conditions? A. Neuroleptic malignant syndrome B. Tardive dyskinesia C. Acute dystonia D. Agranulocytosis

ANS: A Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability.

A 16-year-old client diagnosed with schizophrenia experiences command hallucinations to harm others. The clients parents ask a nurse, Where do the voices come from? Which is the appropriate nursing reply? A. Your child has a chemical imbalance of the brain, which leads to altered thoughts. B. Your childs hallucinations are caused by medication interactions. C. Your child has too little serotonin in the brain, causing delusions and hallucinations. D. Your childs abnormal hormonal changes have precipitated auditory hallucinations. ANS:

ANS: A The nurse should explain that a chemical imbalance of the brain leads to altered thought processes. Hallucinations, or false sensory perceptions, may occur in all five senses. The client who hears voices is experiencing an auditory hallucination.

A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following would be accurate responses by the nurse? Select all that apply. A. Some antianxiety agents have been successful in treating social phobias. B. Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia). C. Specific phobias are generally not treated with medication unless accompanied by panic attacks. D. Beta-blockers have been used successfully to treat phobic responses to public performance.

ANS: A, B, C, D All of the listed pharmacological treatments are evidence-based treatments for phobic disorders.

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse? A. The side effects of medications B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. How to be a leader

ANS: C The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients in communicating needs and maintaining connectedness.

Which nursing intervention would be most appropriate when caring for an acutely agitated client with paranoia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the clients boundaries.

ANS: D The most appropriate nursing intervention is to provide personal space to respect the clients boundaries. Providing personal space may serve to reduce anxiety and thus reduce the clients risk for violence.

____________________ is the subjective emotional response to a stressor or fear.

Anxiety

Atypical antipsychotics

Aripiprazole Brexiprazole Clozapine Olanzapine Quetiapine Asenapine Cariprazine Risperidone Ziprasidone Lurasidone Paliperidone Iloperidone

Prodromal phase of schizophrenia

Average length of 2-5 years Significant deterioration in functioning Socially withdrawn Cognitive impairment Depressive symptoms

A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. I cannot drink any alcohol with this medication. B. It is going to take 2 to 3 weeks in order for me to begin to feel better. C. This drug causes physical dependence, and I need to strictly follow doctors orders. D. I cant take this medication with food. It needs to be taken on an empty stomach.

B. It is going to take 2 to 3 weeks in order for me to begin to feel better. BuSpar takes at least 2 to 3 weeks to be effective in controlling symptoms of anxiety. This is important to teach clients in order to prevent potential noncompliance due to the perception that the medication is ineffective.

anxiolytics for panic disorder

BENZODIAZEPINEs alprazolam lorazepam clonazepam

positive symptoms of schizophrenia

Delusions (persecutory, referential, grandiose, somatic, erotomanic) Hallucinations (auditory, visual, tactile, olfactory, gustatory) Disorganized thinking/speech Disorganized/abnormal motor behavior (hyperactivity, catatonia)

negative symptoms of schizophrenia

Lack of emotional expression/flat affect Lack of motivation Neglectful Alogia / decreased verbal communication Asociality Diminished abstract thinking

___________________________ is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.

Mania

___________________________ is a pervasive and sustained emotion that may have a major influence on a person's perception of the world.

Mood

Phases of Schizophrenia

Premorbid Prodromal Active/Psychotic Residual

antidepressants for generalized anxiety disorder (3 classes)

SSRIs paroxetine escitalopram SNRIs duloxetine venlafaxine ATYPICALs nefazodone mirtazapine

SSRIs TCA for OCD

SSRIs - fluoxetine, paroxetine, fluvoxamine TCA - clomipramine

medication for trichotillomania

SSRIs have moderate results (not consistent)

___________________________ disorder is manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania).

Schizoaffective

antipsychotics for mood stabilization

olanzapine olanzapine + fluoxetine quetiapine asenapine chlorpromazine aripiprazole risperidone lurasidone ziprasidone

premorbid phase of schizophrenia

Socially withdrawn Poor social relationships Poor school performance Introverted

TCA SSRI for body dysmorphia

TCA - clomipramine SSRI - fluoxetine

TCA MAOI SSRIs SNRI atypicals ANTIDEPRESSANTs for agoraphobia / social anxiety disorder

TCA - imipramine MAOI - phenelzine SSRIs - paroxetine & sertraline SNRI - venlafaxine ATYPICALs - nefazodone & bupropion

antidepressants for panic disorder

TCAs clomipramine imipramine SSRIs paroxetine fluoxetine sertraline SNRI venlafaxine

combination drugs for depression

olanzapine + fluoxetine chlordiazepoxide + fluoxetine perphenazine + amitriptyline

3. A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? The following are the outcomes: 1. Maintains nutritional status. 2. Interacts appropriately with peers. 3. Remains free from injury. 4. Sleeps 6 to 8 hours a night.

The nurse should order client outcomes based on priority in the following order: Remains free of injury, maintains nutritional status, sleeps 6 to 8 hours a night, and interacts appropriately with peers. The nurse should prioritize the client's safety and physical health as most important

medications for bipolar depression

olanzapine + fluoxetine quetiapine lurasidone

anticonvulsant for anxiety

pregabalin

continuum spectrum of depression

Transient depression Mild Depression Moderate Depression Severe Depression

typical vs atypical antipsychotics

Typical (improves positive symptoms; worsens negative symptoms) Atypical (improves positive AND negative symptoms)

antihypertensive medications for anxiety

propranolol clonidine

beta blockers for performance / stage fright

propranolol atenolol

residual phase of schizophrenia

active phase symptoms can be present/absent Positive symptoms may improve Negative symptoms are common (flat affect)

benzodiazepines for social anxiety disorder / social phobia

alprazolam clonazepam

Antianxiety drugs are also called ______________________ and minor tranquilizers.

anxiolytics

anxiolytics for generalized anxiety disorder

benzodiazepines BUSPIRONE (10 to 14 day lag)

anticonvulsants for mood stabilization

carbamazepine oxcarbazepine clonazepam valproic acid lamotrigine gabapentin topiramate

antimanic drug for mood stabilization

lithium (maintenance 0.6 - 1.2 // acute mania 0.5 - 1.5)

Traits associated with schizoid, obsessive-compulsive, and _____________________ personality disorders are commonly seen in clients with the diagnosis of BDD.

narcissistic

medications for bipolar mania

olanzapine aripiprazole quetiapine asenapine risperidone ziprasidone cariprazine chlorpromazine

Active Psychotic phase of schizophrenia

psychotic symptoms are present; 1.delusions, 2.hallucinations, impairment in work, social relations, and self-care; 3.disorganized speech (frequent derailment or incoherence) grossly disorganized or catatonic behavior; negative symptoms (diminished emotional expression or avolition) you must have at least one of the three symptoms above during a 1-month period to be active diagnosed

SSRIs

sertraline fluoxetine paroxetine vortioxetine fluvoxamine citalopram escitalopram vilazodone